• Gross profit down 20 per cent and turnover down by nearly a quarter at the four biggest NHS staffing agencies
  • Agency cap reverses turnover growth at biggest firms and dividends slashed at one
  • Companies believe overall demand for healthcare staff will continue to increase

The four largest agencies supplying temporary medical staff to the NHS have seen a 24 per cent fall in turnover, HSJ analysis reveals.

HSJ analysed the latest annual accounts from Medacs Healthcare, Pulse Healthcare, ID Medical Group and Mayday Healthcare – which together saw turnover fall from £549.1m in 2015 to £415.9m in 2016 (see box).

The NHS introduced caps on agency rates in October 2015, and there has been a national drive to cut usage of agency staff.

Gross operating profits across the four firms fell by 20 per cent year on year, from £132.1m to £105.7m.

NHS Improvement put the overall agency bill for 2016-17 at £2.9bn, down from £3.6bn in 2015-16.

The NHS has managed to largely contain the increase in agency nurse costs but has struggled to make the same progress on agency medics.

The annual accounts of the four firms said the cap affected their business but they were confident overall demand for clinical staff would continue.

Medacs’ latest accounts said: “Despite continued growth of the nursing and doctors businesses… short term profitability had been impacted.”

Independent Clinical Services, which owns Pulse, said it was looking to acquire other businesses, invest in IT and broaden its “service offering to selected healthcare service niches via new business units and the development of new services”. It said it was looking at providing public health services such as diabetes support and smoking cessation.

The firm paid out no dividends to shareholders in 2016, after paying £34m in 2015.

ID Medical Group increased its dividends from £1.3m in 2015 to £1.4m in 2016 but reduced its directors’ remuneration from £2.1m to £1.6m. The company has opened an office in India to source staff and reduce administrative costs.

Mayday paid £10m in dividends in 2016, up from £3.5m the previous year.

Impellam Group, which owns Medacs, said it would make no comment. Impellam is chaired by former Conservative Party deputy chair Lord Ashcroft.

ID Medical Group, Mayday, Pulse and NHS Improvement were also approached for comment but did not reply in time for publication.

Indigo Parent Limited, the parent company of Pulse and Independent Clinical Services posted a signficant drop in turnover in papers published on September 29. The company said it was looking to diversify and acquire other businesses. 

Turnover and gross profit of the four biggest staffing agencies



  • Turnover – £114m
  • Gross profit – £26.2m


  • Turnover – £144m
  • Gross profit – £25.2m



  • Turnover – £57.8m
  • Gross profit – £18.1m


  • Turnover – £75.8m
  • Gross profit – £24.9m

ID Medical Group


  • Turnover – £126.7m
  • Gross profit – £23.9m


  • Turnover – £165m
  • Gross profit – £26.2m

Independent Clinical Services (Pulse)


  • Turnover – £117.4m
  • Gross profit – £37.5m


  • Turnover – £164.3m
  • Gross profit – £55.8m

Capital's trusts to introduce 'maximum' caps on agency rates